HIV-Infected Drug Users Face High Risk of Medical Complications

A Yale University study of the health problems of people infected with HIV reveals that those who also have substance abuse problems are at greater risk for other serious illnesses than those who do not— primarily because the substance abuse leads to reduced access and adherence to life-prolonging antiretroviral treatment (ART).

The researchers recommend that integrated treatment options be developed to directly address drug use and underlying mental illness so that HIV treatment can be managed more effectively. Despite daunting challenges, researchers say, effective treatments are now available to successfully manage these patients if stigma is reduced and resources leveraged to provide treatment. The study is being presented July 20 at the annual International AIDS Society conference in Vienna, and will be published in The Lancet.

According to the Yale researchers, these complications are also compounded by a number of secondary conditions such as viral hepatitis, tuberculosis, bacterial infections, and renal and cardiovascular disease.

Effective treatments for substance abuse and HIV are known, but these treatments are insufficiently available. Even where they are, HIV-infected drug users are often excluded from antiretroviral treatment, the researchers say.

“The number and range of these concurrent disorders complicates diagnosis and treatment. They must be addressed all at once, preferably in an integrated approach, in order to achieve health outcomes on a par with those who do not use drugs,” said lead author Frederick L. Altice, M.D., professor of medicine at Yale School of Medicine and director of clinical and community research for the Yale University AIDS Program, noting that injection drug use especially poses severe challenges.

Another issue, the team writes, is that drug and alcohol dependence are associated with decreased access to and use of health care and reduced likelihood of being prescribed antiretroviral therapy.

Altice’s team recommends evidence-based treatment that can improve the psychological and physiological problems that perpetuate the “often unstable” life of HIV-infected and drug-dependent people. These include a range of interventions, such as counseling, contingency management, supervised therapy, medication-assisted therapy and integrated health services delivery, note the researchers.

The team also found that incarceration is detrimental to HIV-infected drug users because it makes them more susceptible to illnesses such as drug-resistant tuberculosis and other infections associated with contained settings.

“Once effective treatment is initiated, successful transitional programs and continuity of care after release to the community are desperately needed,” Altice said.

Altice‘s international collaborators are Adeeba Kamarulzaman, M.D. (Malaysia), Vicente Soriano, M.D. (Spain), Mauro Schechter, M.D., Ph.D. (Brazil), and Gerald H. Friedland, M.D., of Yale School of Medicine.

Funding was provided by the National Institute on Drug Abuse of the National Institutes of Health.

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